Histogenesis of human stomach cancers based on assessment of differentiation

The histogenesis of human stomach cancer was assessed based on the determination of the differentiation of component cancer cells. Specimens of 229 surgically obtained primary gastric cancers were used. Histochemical staining of mucins [paradoxical concanavalin A, galactose oxidase-Schiff (GOS), and sialidase-GOS sequence] and immunohistochemical demonstration of pepsinogens (Pg) I and II allowed the differentiation of gastric elements including mucous neck cells, pyloric gland cells, and surface mucous cells as well as intestinal goblet and absorptive cell types. Of 122 papillary and tubular adenocarcinomas, the proportion consisting mainly of intestinal type cells increased with progression from 22.9% (early) to 41.9% (advanced). Similarly, intestinal features increased with progression from 8.3% (early) to 25.4% (advanced) in the 107 poorly differentiated adenocarcinomas, signet ring cell carcinomas, and mucinous adenocarcinomas studied. A phenotypic shift from gastric- to intestinal-type expression was thus observed with progression of each histologic type of gastric cancer. Furthermore, tumors consisting mainly of gastric-type cells were commonly found within intestinal metaplastic mucosa, suggesting that this latter is not a preneoplastic lesion for gastric cancers in humans.